Healthcare Provider Details

I. General information

NPI: 1225788698
Provider Name (Legal Business Name): BIANCA MONTALVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S GODDARD BLVD
KING OF PRUSSIA PA
19406-2922
US

IV. Provider business mailing address

100 LENNOX CT
LANSDALE PA
19446-6378
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-3232
  • Fax:
Mailing address:
  • Phone: 203-217-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP025732
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN710420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: